netFormulary NHS
NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
 Search
 Formulary Chapter 8: Malignant disease and immunosuppression - Full Chapter
Notes:

Hameatology/Oncology related Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

Haematology/Oncology related Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.

 

 Details...
08.02  Expand sub section  Drugs affecting the immune response
Blinatumomab
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
 
Link  NICE TA450 : Blinatumomab for previously treated Philadelphia-chromosome-negative acute lymphoblastic leukaemia
 
08.02.01  Expand sub section  Antiproliferative immunosuppressants
Azathioprine
(Tablets)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 25mg and 50mg tablets
  • Chemotherapy/post transplant
 
 
Mycophenolate Mofetil
(Oral )
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
  • 250mg capsules
  • 500mg tablets
 
Link  Mycophenolate mofetil, mycophenolic acid: new pregnancy-prevention advice for women and men
 
08.02.02  Expand sub section  Corticosteroids and other immunosuppressants
Ciclosporin
(Capsules)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 25mg, 50mg and 100mg capsules
  • Indicated for bone marrow stem cell transplant.
  • The brand to be dispensed should be specified by the prescriber due to differences in bioavailability.
  • Preparations are not interchangeable.
  • RUH and SFT - Neoral

 

 
 
Tacrolimus
(Capsules)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 500microgram, 1mg and 5mg capsules
  • Indicated for bone marrow stem cell transplant.
  • The brand to be dispensed should be specified by the prescriber due to differences in bioavailability.
  • Preparations are not interchangeable.
 
Link  Oral tacrolimus products: reminder to prescribe and dispense by brand name only
 
Ciclosporin
(Capimune ®Deximune®Neoral®)
(Capsules)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 25mg, 50mg and 100mg capsules
  • For SOLID organ transplant patients continue on brand specifed by the specialist.
  • Preparations are not interchangeable.
  • NHSE commissioner when ciclosporin used for solid organ transplants. Available from Specialist Centres ONLY.

 

 
 
Ciclosporin (Sandimmun®)
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
  • Infusion 50mg/ml
 
 
Tacrolimus
(AdoPORT ®Prograf®Advagraf®)
(Capsules)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • AdoPORT 500microgram, 750microgram, 1mg, 2mg and 5mg capsules
  • Prograf 500micrograms, 1mg, and 5mg capsules 
  • Advagraf 500microgram, 1mg, 3mg, 5mg modified release capsules
  • For SOLID organ transplant patients continue on brand specifed by the specialist prescriber.
  • Preparations are not interchangeable.
  • NHSE commissioner when tacrolimus used for solid organ transplants. Available from Specialist Centres ONLY.

 

 

 

 
 
08.02.03  Expand sub section  Anti-lymphocyte monoclonal antibodies
Alemtuzumab
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 12mg/1.2ml infusion
 
Link  Feb 2020 MHRA DSU - Lemtrada▼ (alemtuzumab): updated restrictions and strengthened monitoring requirements following review of serious cardiovascular and immune-mediated reactions
Link  NICE TA312: Alemtuzumab for relapsing‑remitting multiple sclerosis
Link  MHRA Drug Safety Update (May 2019):Lemtrada (alemtuzumab) and serious cardiovascular and immune-mediated adverse reactions
 
Obinutuzumab
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
 
Link  NICE TA343: Obinutuzumab with chlorambucil for CLL
Link  NICE TA513:Obinutuzumab for untreated advanced follicular lymphoma
 
Ocrelizumab
(injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 300mg vial
 
Link  NICE TA533: Ocrelizumab for treating relapsing–remitting multiple sclerosis
Link  NICE TA585: Ocrelizumab for treating primary progressive multiple sclerosis
 
Rituximab (Truxima)
(injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 100mg/10ml and 500mg/50ml infusion
  • Prescribe by Brand Biosimilar First Line
 
Link  NICE TA 137 Rituximab for the treatment of relapsed or refractory stage III or IV follicular non-Hodgkin’s lymphoma
Link  NICE TA 243 Rituximab for the first-line treatment of stage III-IV follicular lymphoma
Link  NICE TA174 Rituximab for the first-line treatment of chronic lymphocytic leukaemia
Link  NICE TA193 Rituximab for the treatment of relapsed or refractory chronic lymphocytic leukaemia (TA193)
Link  NICE TA226 Rituximab for the first-line maintenance treatment of follicular non-Hodgkin’s lymphoma
Link  NICE TA649 Polatuzumab vedotin with rituximab and bendamustine for treating relapsed or refractory diffuse large B-cell lymphoma
 
Rituximab (MabThera®)
(Subcutaneous injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 1400mg/11.7ml injection
  • For single agent maintenance for follicular lymphoma according to NHSE Circular SSC 1434 July 2014
  • Prescribe by Brand
 
 
08.02.04  Expand sub section  Other immunomodulating drugs to top
Dimethyl fumarate
(Oral)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 120mg and 240mg capsules
  • NB Tecfidera brand only licensed for Multiple Sclerosis
  • Check full blood counts before prescribing dimethyl fumarate and then every 6 to 12 months. Stop treatment immediately if progressive multifocal leukoencephalopathy is suspected.
 
Link  NICE TA320: Dimethyl fumarate for multiple sclerosis
Link  MHRA DSU Jan 2021 Dimethyl fumarate (Tecfidera): updated advice on the risk of progressive multifocal leukoencephalopathy (PML) associated with mild lymphopenia
Link  MHRA DSU Mar 2015 Dimethyl fumarate (Tecfidera): fatal PML in an MS patient with severe, prolonged lymphopenia
 
Dinutuximab
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 20mg/4.5ml infusion
  • Only for use in line with NHSE commissioning (see link below)

 

 

 
Link  NICE TA538: Dinutuximab beta for treating neuroblastoma
 
Fingolimod
(Capsules)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 0.5mg capsules
 
Link  NICE TA254: Fingolimod for highly active relapsing remitting multiple sclerosis
Link  Clinical Commissioning Policy: Disease Modifying Therapies for Patients with Multiple Sclerosis (MS)
Link  EMC Risk Minimisation materials: Gilenya (fingolimod)
Link  MHRA DSU Jan 2021 Fingolimod (Gilenya): updated advice about the risks of serious liver injury and herpes meningoencephalitis
Link  MHRA DSU Sep 2019 Fingolimod (Gilenya): increased risk of congenital malformations; new contraindication during pregnancy and in women of childbearing potential not using effective contraception
Link  MHRA DSU Dec 2017 Fingolimod (Gilenya): new contraindications in relation to cardiac risk
Link  MHRA DSU Dec 2017 Fingolimod (Gilenya): updated advice about risk of cancers and serious infections
 
Lenalidomide
(Capsules)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
 
Link  Immunomodulatory drugs and pregnancy prevention: temporary advice for management during coronavirus (COVID-19)
Link  Lenalidomide (Revlimid): risk of serious hepatic adverse drug reactions – routine monitoring of liver function now recommended
Link  Lenalidomide: risk of thrombosis and thromboembolism
Link  NICE TA 322 Lenalidomide for treating myelodysplastic syndromes associated with an isolated deletion 5q cytogenetic abnormality
Link  NICE TA 586 Lenalidomide plus dexamethasone for multiple myeloma after 1 treatment with bortezomib
Link  NICE TA171: Lenalidomide for the treatment of multiple myeloma in people who have received at least 2 prior therapies
Link  NICE TA587 Lenalidomide plus dexamethasone for previously untreated multiple myeloma
 
Niraparib
(Capsules)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
 
 
Nivolumab
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
 
Link  Oct 2019 - reports of cytomegalovirus (CMV) gastrointestinal infection or reactivation
Link  NICE TA384: Nivolumab for treating advanced (unresectable or metastatic) melanoma
Link  NICE TA400: Nivolumab in combination with ipilimumab for treating advanced melanoma
Link  NICE TA417: Nivolumab for previously treated advanced renal cell carcinoma
Link  NICE TA462 : Nivolumab for treating relapsed or refractory classical Hodgkin lymphoma
Link  NICE TA655: Nivolumab for advanced squamous non-small-cell lung cancer after chemotherapy
 
Olaparib
(Oral)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 50mg capsules
  • NB other strengths exist these are not formulary

 

 
Link  NICE TA381: Olaparib for maintenance treatment of relapsed, platinum-sensitive, BRCA mutation-positive ovarian, fallopian tube and peritoneal cancer after response to second-line or subsequent platinum-based chemotherapy
Link  NICE TA598: Olaparib for maintenance treatment of BRCA mutation-positive advanced ovarian, fallopian tube or peritoneal cancer after response to first-line platinum-based chemotherapy
 
Osimertinib
(Capsules)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 40mg and 80mg tablets
 
Link  NICE TA 653: Osimertinib for treating EGFR T790M mutation-positive advanced non-small-cell lung cancer
Link  NICE TA654: Osimertinib for untreated EGFR mutation-positive non-small-cell lung cancer
 
Panobinostat
(Capsules)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 10mg, 15mg and 20mg capsules
 
Link  NICE TA380: Panobinostat for treating multiple myeloma after at least 2 previous treatments
 
Pegaspargase
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 3,750mg/5ml injection
 
Link  NICE TA408: Pegaspargase for treating acute lymphoblastic leukaemia
 
Pomalidomide
(Capsules)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
 
Link  Immunomodulatory drugs and pregnancy prevention: temporary advice for management during coronavirus (COVID-19)
Link  NICE TA388: Pomalidomide for myeloma
Link  NICE TA427: Pomalidomide for multiple myeloma previously treated with lenalidomide and bortezomib
 
Siponimod
(Tablets)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 250 microgram and 2mg film coated tablets
 
Link  NICE TA656: Siponimod for treating secondary progressive multiple sclerosis
 
Teriflunomide
(Tablets)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 14mg tablets
 
Link  Clinical Commissioning Policy: Disease Modifying Therapies for Patients with Multiple Sclerosis (MS)
Link  NICE TA303: Teriflunomide for relapsing remitting MS
 
Thalidomide
(Capsules)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 50mg capsules
 
Link  Immunomodulatory drugs and pregnancy prevention: temporary advice for management during coronavirus (COVID-19)
Link  NICE TA228: Bortezomib and thalidomide for the first‑line treatment of multiple myeloma
 
08.02.04  Expand sub section  Interferon Alfa
Peginterferon Alfa (Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 90microgram/0.5ml, 135microgram/0.5ml and 180microgram/0.5ml pre-filled syringes
 
Link  NICE TA106: Hepatitis C - peginterferon alfa & ribavirin
Link  NICE TA200: Hepatitis C - peginterferon alfa & ribavirin
Link  NICE TA300: Hepatitis C - peginterferon alfa
Link  NICE TA75: Hepatitis C - pegylated interferons, ribavirin & alfa interferon
Link  NICE TA96: Hepatitis B - peginterferon alfa
 
Peginterferon Alfa (Injection )
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
  • 90microgram/0.5ml, 135microgram/0.5ml and 180microgram/0.5ml pre-filled syringes
  • For the treament of leukaemia and lymphoma in accordance with cancer network guidelines
  • For the treatment of Myeloproliferative Neoplasms e.g Essential Thrombocythaemia, Polycythaemia after hydroxycarbamide or anagralide.
 
 
08.02.04  Expand sub section  Interferon beta
Interferon Beta
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 30microgram/0.5ml pre-filled (6 million units) syringes
 
Link  Clinical Commissioning Policy: Disease Modifying Therapies for Patients with Multiple Sclerosis (MS)
Link  NICE TA527 Beta interferons and glatiramer acetate for treating multiple sclerosis
 
Interferon Beta
(Extavia®)
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • Extavia® 250 microgram/ml powder and solvent for solution for injection
  • After reconstitution, each ml contains 250 microgram (8.0 million IU) of recombinant interferon beta-1b
 
Link  Clinical Commissioning Policy: Disease Modifying Therapies for Patients with Multiple Sclerosis (MS)
Link  NICE TA527 Beta interferons and glatiramer acetate for treating multiple sclerosis
 
Interferon Beta (Rebif®)
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 22micrgoram/0.5ml and 8.8microgram/0.2ml cartridges and pre-filled pens/syringes
  • 44microgram/0.5ml cartridges and pre-filled pens/syringes
 
Link  Clinical Commissioning Policy: Disease Modifying Therapies for Patients with Multiple Sclerosis (MS)
Link  NICE TA527: Beta interferons and glatiramer acetate for treating multiple sclerosis
 
Peginterferon Beta-1a (Injection )
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 63microgram/0.5ml, 94microgram/0.5ml and 125microgram/0.5ml pre-filled pens
 
Link  Clinical Commissioning Policy: Disease Modifying Therapies for Patients with Multiple Sclerosis (MS)
Link  Link NICE TA527: Beta interferons and glatiramer acetate for treating multiple sclerosis
 
08.02.04  Expand sub section  Glatiramer acetate
Glatiramer Acetate
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 20mg/1ml and 40mg/1ml injection
 
Link  Clinical Commissioning Policy: Disease Modifying Therapies for Patients with Multiple Sclerosis (MS)
Link  NICE TA527 Beta interferons and glatiramer acetate for treating multiple sclerosis
 
08.02.04  Expand sub section  Lenalidomide, pomalidomide, and thalidomide
Clarithromycin
(Tablets)
View adult BNF View SPC online
Formulary
traffic lightRed
  • RUH only
  • Used in combination with lenalidomide and pomalidomide as per DTC899
  • 250mg and 500mg tablets
 
 
08.02.04  Expand sub section  Mifamurtide to top
Mifamurtide
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
  • 4mg infusion
  • When used in line with NICE TA235 (as below) and initiated by specialist centres ONLY 

 

 
Link  NICE TA235: Osteosarcoma - mifamurtide: guidance
 
08.02.04  Expand sub section  Natalizumab
Natalizumab
(Injection)
View adult BNF View SPC online
Formulary
traffic lightRed
High Cost Medicine
NHS England
  • 300mg/15ml infusion
 
Link  Clinical Commissioning Policy: Disease Modifying Therapies for Patients with Multiple Sclerosis (MS)
Link  NICE TA127: Multiple sclerosis - natalizumab
 
 ....
 Non Formulary Items
Fampridine

View adult BNF View SPC online
Non Formulary
High Cost Medicine
 
Interferon Alfa
(Roferon-A®)

View adult BNF View SPC online
Non Formulary
High Cost Medicine
  • DISCONTINUED

 

  • Pre-filled syringes 3 million / 4.5 million / 6 million International Units interferon alfa-2a* per 0.5 millilitres
  • For the treament of leukaemia and lymphoma in accordance with cancer network guidelines
  • For the treatment of Myeloproliferative Neoplasms e.g Essential Thrombocythaemia, Polycythaemia after hydroxycarbamide or anagralide.
 
Mycophenolate Sodium

View adult BNF View SPC online
Non Formulary
 
Prednisolone
(Post- transplant)

View adult BNF View SPC online
Non Formulary
 
Prednisolone
(Immunosuppressant)

View adult BNF View SPC online
Non Formulary
 
Sirolimus (Rapamune®)

View adult BNF View SPC online
Non Formulary
High Cost Medicine
  • Non Formulary Except when used in accordance with NHSE Commissioning Policy for Solid Organ Transplants within specialist centres (not RUH SFT GWH)
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Traffic LightRed

RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Traffic LightAmber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Traffic LightAmber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Traffic LightGreen

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Traffic LightBlack

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Traffic LightRed Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

netFormulary